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For all three groups described here, I believe it is safe to say that gender dysphoria is the single most dominating influence during developmental stages in all three groups.

In this paper, I will take examples from my case load to show how gender dysphoria effects these people at each of the classic five stages of life: childhood, adolescence, early adulthood, midlife and old age.

They develop an aura of deep secrecy based on shame and risk of ridicule and their secret desire to be female is protected at all costs.

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Typically, from earliest childhood these individuals suffer increasingly painful and chronic gender dysphoria.They tend to live secretive lives, often making increasingly stronger attempts to convince themselves and others that they are male.With little investment in trying to live as their assigned birth sex and with a lot of practice in living as closely as possible to their desired sex, these individuals report relatively low levels of anxiety about their dilemma.For those who decide transition is in their best interest, they accomplish the change with relatively little difficulty, particularly compared to G3, female-identified males. In the hope of ridding themselves of their dysphoria they tend to invest heavily in typical male activities.The further an individual gets from believing he can ever live as a female, the more acute and disruptive his dysphoria becomes.

Given gender identity permanency and its obvious importance in the ordering of one's life, it is reasonable to consider gender identity as essential existential knowledge, knowledge that can not be unknown or separated out from the whole without radically redefining the whole.

Essentially creating a not-male, not-female but otherwise permanent gender variant condition.

Even though there apparently are some individuals who fall very close to or dead-center on the gender identity spectrum, most gender variant people can easily identify with being closer to one end of the spectrum then the other.

Further, they make little or no effort to engage in what they feel for them would be wrong gendered social practices (i.e., the gender role assigned at birth as the basis of authority).

Although I have seen some notable exceptions, especially in male-identified females, these individuals--at the time of presentation for treatment--are rarely married or have children, are rarely involved in the corporate or academic culture and are typically involved in the service industry at a blue- or pink-collar level.

As a psychotherapist I have found female identified males (G1) to be clinically similar to male-identified females (G2).